Developmental Trauma Disorder: A new proposed diagnosis for the DSM-V

Should there be a separate diagnostic category for complex PTSD related to childhood trauma in the DSM-V?

Physicians and researchers such as Bessel van der Kolk, MD, Robert Pynoos, MD, and Marylene Cloitre , PhD think so. Over a year ago, these medical professionals formed a task force advocating that a diagnosis called Developmental Trauma Disorder be in the DSM-V.

The task force notes the diagnostic criteria for the current diagnosis of PTSD was based on symptoms of World War II combat veterans. We know that many people who have have experienced chronic childhood abuse or neglect also exhibit some PTSD symptoms. But, they also display problems with emotional regulation, learning disabilities, and attachment that are given separate diagnoses and treated differently.

At a conference I attended in February 2010, Dr. van der Kolk opined this lack of an adequate diagnostic code resulted in dangerous consequences for kids. He estimates that as many as 8 million children in the U.S.A. have been diagnosed with Bipolar Disorder and/or ADHD and prescribed large doses of medication. Yet, he’s observed the root of the problem for many of these kids lies in disrupted attachment, abuse, or neglect that is often left untreated.

Similarly, as abused kids reach adulthood they are given diagnoses of recurrent depression, anxiety disorders, personality disorders, or somatization disorders because they don’t match the current criteria for PTSD. Not only do these patients have to live with the stigma of other diagnoses, but it also leaves the root cause of the problem untreated.

Fortunately, Cloitre et. al just published an article in the August 2010 addition of the American Journal of Psychiatry that lends more support for this new diagnosis. Their research illustrates that treatment for issues related to chronic childhood traumas is different. See my post titled “Complex PTSD requires emotional skills training + trauma focused therapy” for information about this research.

Similarly research by Pitman, et al. presented at the 2008 ANCP meeting found that diminished volume of the hippocampus and ventro-medial pre-frontal cortex seemed to make a person more vulnerable to developing PTSD. We know that people exposed to chronic stress, especially as a child, tend to have diminished volume in these areas. Having diminished volume in these areas makes it more difficult to regulate emotions and assemble memory.

Diagnosing these issues appropriately has important implications for treatment. For example, Cloitre’s research suggests we have to do a combination of emotional skills training and trauma focused therapy for optimal treatment response. For children, it suggests family counseling with parenting support and coaching is needed for optimal treatment responses.

Even if the new diagnosis is accepted for the upcoming DSM-V, it would only be approved as a diagnosis for children and adolescents at this time, not adults. Still, it would be a step in the right direction in terms of getting these folks appropriate treatment.

What do you think? Do you think there needs to be separate diagnostic category for complex PTSD related to childhood trauma in the upcoming DSM-V?

For more information about this proposal and the suggested diagnostic criteria, visit www.traumacenter.org.

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